Causes of Infertility


Endometriosis is a very common condition in reproductive age females.

Although the cause of endometriosis is not clear, it results in endometrial tissue, which normally resides inside the uterus growing and implanting on the surfaces of the internal organs including the ovaries and the base of the uterus. Every month during menstruation, the tissue grows and bleeds resulting in inflammation, scarring and pain.

Risk factors for endometriosis include the following.

  • history of pelvic pain
  • pain with intercourse
  • premenstrual spotting
  • family history of endometriosis
  • infertility

Treatment for endometriosis associated with pelvic pain includes surgical treatment by a laparoscopic techniques especially CO2 laser.

It is important to identify a highly trained reproductive surgeon who is competent to perform this procedure.

New techniques including robotic surgery allow better visualization of endometriosis and increased ability to excise deeply embedded disease.

Mild verses severe endometriosis

The recent controversy regarding the role of minimal and mild endometriosis and its effect on infertility. In the past it was felt to be important to perform laparoscopy every infertility patient to identify and treat even mild conditions.

Contemporary thinking has evolved to the point where it is now considered that minimal and mild endometriosis does not significantly impact fertility, and is not necessary to treat these early stages of the disease because of this. It still felt by most experts that moderate and severe endometriosis, especially in the presence of an endometrioma, impacts pregnancy rates significantly and that the endometriosis should be surgically treated prior to initiating fertility treatment.

Once endometriosis has been treated, is important to quickly initiate therapy for treatment of infertility and/or suppressive therapy for treatment of pain. Endometriosis is a recurrent disease and there is a six-month to one-year window where the disease will be in remission after surgical treatment providing a window of opportunity. If the patient is not placed on suppressive therapy, or does not become pregnant there is a significant risk that the disease will recur and she will require repeat treatment

Suppressive therapy includes birth control pills, and GnRH analogues, which give long-term suppression of ovulation and inhibit further growth of endometrial tissue. A significant side effect of these medications over long periods of time as osteoporosis, which is why these medications cannot be used indefinitely

New research under endometriosis focuses on the difference in cell types between the individual cells growing in the cavity in those growing apparently inside the pelvis it is thought by identifying the differences between the these two cells will be able to develop therapy specifically directed at the endometriosis which does not compromise the growth and integrity of the uterine environment.

Contact us to schedule a patient evaluation for endometriosis with Dr. Mark Denker, a fertility specialist and Fellowship Trained Reproductive Endocrinologist.